Diagnostic accuracy of the Dutch version of the Somatic Symptom Disorder – B Criteria Scale (SSD-12) compared to... 2023 van der Feltz-Cornelis et al

Highlights

• The SSD-12 can be used to screen for somatic symptom related disorders(SSRDs).
• For SSRDs, the SSD-12 is more sensitive and specific than other widely used measures.
• The SSD-12 can distinguish SSRDs from other mental disorders.

Abstract

Objective
Somatic Symptom and Related Disorders(SSRD) are characterised by an intense focus on somatic symptoms that causes significant distress. A self-report scale developed to assess distress as symptom-related thoughts, feelings, and behaviors (SSD-12) has proved to be a reliable, valid and time-efficient measure for Somatic Symptom Disorder(SSD). This cross-sectional study aimed to compare the SSD-12 with psychiatric assessment as gold standard in a Dutch clinical population for SSRD compared to other widely used measures.

Methods
Data were collected from adult patients visiting a specialised mental health outpatient clinic for SSRD in the Netherlands, between 2015 and 2017. Analyses included item evaluation, scale reliability, construct validity, diagnostic utility and cut points. Performance of SSD-12, Whiteley Index(WI) and PHQ-15 were compared in Receiver operating characteristics (ROC) curves.

Results
223 patients with SSD, Functional Neurological Disorder, Illness Anxiety(IA) and no SSRD participated. SSD-12 items were normally distributed; total scores correlated with measures of health anxiety, anxiety and depression. The optimal cut point for the SSD-12 was 22 (sensitivity 75.9%, specificity 63.6%). The ROC area under the curve for SSD-12 was 0.75 compared to 0.68 for the WI and 0.65 for the PHQ-15. Combinations of those questionnaires did not yield better results than for the SSD-12 alone.

Conclusion
The SSD-12 alone outperformed the WI and PHQ-15 and combined scales in effectively distinguishing SSRDs from other mental disorders. This may suggest that distress is a more accurate indicator of SSRD than earlier diagnostic criteria as operationalised in the WI and PHQ-15.

Open access, https://www.sciencedirect.com/science/article/pii/S0022399923003173

 

I continue to be astonished just how absurdly stupid and incompetent this whole idea is.

If people are distressed, it's most likely for a good reason (a marker of the severity of the problem), and an inability to explain the illness medically does not mean that there is no good reason.

When this is labelled as a problem of "focussing of smptoms", "excessive preoccupation with symptoms" and so on, it puts these poor patients on a path where the real problem can never be solved and the patients are condemned to endure it without hope of improvement, and also to be told that they are the problem. The predictable outcome is increased suicide rates, which are of course going to be interpreted as signal that more mental health is needed (as opposed to less), and patients becoming extremely angry and distrusting (which will also be interpreted as evidence the patients have a psychological disorder).

The thing about excessive reactions to symptoms is that it's impossible for healthy people to even imagine how terrible some symptoms are. The patients will inevitably look like they're overreacting when they're simply breaking under the constant torture.

 

It's worthless comparing to people's opinions. The main lesson of science is that you need objective measurements. Comparing some arbitrary tool to expert opinion is not a serious thing. "Gold standards" are meaningless, you need a ground truth, an objective measurement that is absolute, relates to a quantity, not a quality. They're comparing a guesstimate with another guesstimate. How does anyone involved in this not see how ridiculous this is?

Might as well be comparing some thermometer in the 15th century with the guesstimates of a few temperature experts. It's just as worthless. It's not scientific in the slightest.

And obviously the idea of separating focus from senses is beyond silly. Pain is not something anyone needs to focus on to feel, and the same with symptoms. Symptoms don't care about focus, they are a thing of their own. Anyone who experiences symptoms will seem to "focus" on them, if you want to, but really it isn't. What a bunch of clownish nonsense. This all makes as much sense as the idea of a "poverty mentality". It doesn't. Not one bit, it's just condescending bigotry.

 

Very well put. The whole thing is so perverse.

If you’ve had to sit there while a person in good health has either implicitly or explicitly suggested that you’re ‘overly’ focused on your symptoms, it makes you want to scream.

That first moment when you realise that being sick, sicker than you ever have been before, is effectively being used against you is shocking.

When you realise that reacting in a natural human way to chronic unpleasant symptoms and forced changes to your lifestyle is being presented as pathological behavior - it takes a while to get over that.